This document discusses esophageal atresia with tracheo-esophageal fistula (EA/TEF), including the causes, types, symptoms, diagnosis, and management. EA/TEF occurs when the esophagus fails to form a continuous passage from the pharynx to the stomach during embryonic development. The most common type is Type III EA/TEF, where the proximal esophagus ends blindly while the distal segment connects to the trachea via a fistula. Symptoms include excessive salivation, coughing, and cyanosis. Diagnosis involves tests like catheterization and imaging. Management consists of positioning, nothing by mouth, oxygen, IV fluids, and later surgical anastomosis of the esophageal

1. ESOPHAGEAL ATRESIA WITH
TRACHEO-ESOPHAGIAL FISTULA

2. ESOPHAGIAL ATRESIA
• Esophageal atresia is failure of the esophagus to form
a contentious passage from pharynx to stomach during
embryonic development.

3. TRACHEO ESOPHAGIAL FISTULA
• Esophageal atresia is failure of the esophagus to form
a contentious passage from pharynx to stomach during
embryonic development.

4. ETIOLOGY
1. GENETIC DEFECT:-
Mutation in genetic structure of baby during embryonic
development may lead to abnormal development of organ.
2. TERATOGENIC STIMULI:-
Radiation, maternal infection, chemicals and drugs.
3. INTRAUTERINE CAUSES:-
Infections like TORCH can cross placental barrier and can leads
to intrauterine triggering.

5. ETIOLOGY
4. Anomalies may develop due to aberration or deviation from septum
between esophagus and trachea or alteration in growth of spleen.
5. TEF :- Develop due to failure of separation of esophagus and
trachea during embryonic development.
6. EA:- Develops due to deficient growth of dorsal wall of esophagus.

6. INCIDENCE
• Esophageal atresia with or without an associated TEF is the most
common esophageal malformation, occurring in approximately 1 in
3500 live births. There appears to be an equal sex incidence, but the
birth weight of most affected infants is significantly lower than
average, and incidence of prematurity is usually high.

7. CLASSIFICATION

8. CLASSIFICATION
Type I – EA without fistula (8%):-
There is no connection of esophagus to trachea. The upper (proximal)
segment and lower (distal) segment of esophagus are blind.

9. CLASSIFICATION
Type II – EA with TEF (upper).
It is rare and found in less than 1 percent of all cases. Upper segment of
esophagus open into trachea by a fistula. The distal or lower segment is blind.

10. CLASSIFICATION
Type III – EA with TEF (80-90%):-
It is the most common type. In this condition, proximal or upper
segment of the esophagus has blind end. The distal lower segment of
esophagus connects into trachea by a fistula.

11. CLASSIFICATION
Type IV – EA with TEF of both upper and lower segment:-
It is also rare (less than 1%). There is EA with fistula between both
proximal and distal ends of trachea and esophagus.

12. CLASSIFICATION
Type V -H type TEF:-
It is found in about 4% of all cases and not usually diagnosed at birth.
Both proximal/upper and distal/lower segments of esophagus open into
trachea by a fistula.. no EA present.

13. CLINICAL MANIFESTATION
1. Excessive salivation
2. Constant drabbling of saliva
3. Large amount of secretions from nose.
4. Coughing, gaging, choking.
5. Cyanosis:- Intermittent unexplained cyanosis due to laryngospasm caused
by accumulated saliva.
6. Regurgitation of feeding may be entering into respiratory system through
fistula during inspiration.

14. DIAGNOSTIC EVALUATION
1. CATHETERIZATION:- Inability of passing catheter from nose or mouth
to stomach indicates blind pouch or atresia.
2. ANTENATAL DIAGNOSIS:- By USG of abdomen in antenatal period.
3. POSTNATAL DIAGNOSIS:- By USG, plain X-ray examination of
abdomen, chest X-ray, passing of radio opaque catheter through esophagus
and conforming anomalies by X-ray.
4. BRONCHOSCOPY
5. ECG and ECHOCARDIOGRAM:- To detect associated cardiac
disorders.

15. MANAGEMENT
A) IMMIDIATE MANAGEMENT:-
1) Propped Up position:- 30* elevation. 30* to revert gastric
secretion reflex.
2) Neel by mouth (NBM)
3) Oxygen therapy
4) I.V. therapy
5) Nasogastric tube feeding
6) Frequent suctioning to prevent aspiration
7) Saline irrigation of blind pouch & prevent blockage of tube.
8) Gastrostomy:- creating a artificial opening

16. MANAGEMENT
9) Supportive care:-
Maintenance of nutritional level
Prevention of infection
Antibiotics
Respiratory support
Detection and treatment of complications
Chest physiotherapy
Postural drainage

17. MANAGEMENT
B) SURGICAL MANAGEMENT:-
1.) End to end anastomosis with excision of fistula by “Right posterolateral
thoracotomy” followed by “intercostal chest drainage”. Indications are:-
Infant’s weight more then 2 kg.
No pneumonia should be evident.
Stages are:-
Gastrostomy esophageal anastomosis or colonic transplant after 1 year.

18. NURSING MANAGEMENT
PRE OPERATIVE:-
- Prevent aspiration
- Prevent dehydration
- Infection control
- Reducing parental anxiety
POST OPERATIVE:-
- Maintain clear airway
- Fluid balance and feeding
- Analgesics for pain
- Chest tube drainage